NPI | 1285769471 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 2247) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 642) |
Enumeration Date | 2007-02-21 |
Last Update Date | 2008-08-10 |